Abstinence-contingent wage supplements to promote drug abstinence and employment: a randomised controlled trial

Abstract

BackgroundPoverty, unemployment and substance abuse are inter-related problems. This study evaluated the effectiveness of abstinence-contingent wage supplements in promoting drug abstinence and employment in unemployed adults in outpatient treatment for opioid use disorder.MethodsA randomised controlled trial was conducted in Baltimore, MD, from 2014 to 2019. After a 3-month abstinence initiation and training period, participants (n=91) were randomly assigned to a usual care control group that received employment services or to an abstinence-contingent wage supplement group that received employment services plus abstinence-contingent wage supplements. All participants were invited to work with an employment specialist to seek employment in a community job for 12 months. Abstinence-contingent wage supplement participants could earn training stipends for working with the employment specialist and wage supplements for working in a community job, but had to provide opiate and cocaine-negative urine samples to maximise pay.ResultsAbstinence-contingent wage supplement participants provided significantly more opiate and cocaine-negative urine samples than usual care control participants (65% vs 45%; OR=2.29, 95% CI 1.22 to 4.30, p=0.01) during the 12-month intervention. Abstinence-contingent wage supplement participants were significantly more likely to have obtained employment (59% vs 28%; OR=3.88, 95% CI 1.60 to 9.41, p=0.004) and lived out of poverty (61% vs 30%; OR=3.77, 95% CI 1.57 to 9.04, p=0.004) by the end of the 12-month intervention than usual care control participants.ConclusionAbstinence-contingent wage supplements can promote drug abstinence and employment.Trial registration numberClinicalTrials.gov NCT02487745.

An Examination of the Feasibility of Detecting Cocaine Use Using Smartwatches

“…Participants from both the Pilot and Main phases were recruited from the Center for Learning and Health in the Department of Psychiatry and Behavioral Sciences at the Johns Hopkins University School of Medicine in Baltimore, MD, between May 2017 and March 2018. Participants were unemployed cocaine-using adults who were enrolled in a concurrent study at the site, known as the parent study (National Institute on Drug Abuse, R01DA037314, PI: Silverman) ( 13 ). Participation was offered to individuals who were active in the Induction Period of the parent study (days 8–35, during which participants were not expected to abstain from drug use and were exposed to the same conditions) at the time of study intake and had provided a cocaine-positive urine sample in the week prior (based on thrice-weekly urine samples collected as a part of the parent study).…”

“…Participation was offered to individuals who were active in the Induction Period of the parent study (days 8–35, during which participants were not expected to abstain from drug use and were exposed to the same conditions) at the time of study intake and had provided a cocaine-positive urine sample in the week prior (based on thrice-weekly urine samples collected as a part of the parent study). For a detailed description of the Induction Period, see ( 13 ). Briefly, participants were offered access to paid job-skills training in a model therapeutic workplace during the Induction Period.…”

Behavior Analysis in the War on Poverty: The Therapeutic Workplace Wage Supplement Program

“…The Therapeutic Workplace wage supplement program. A randomized control trial evaluated the utility of a Therapeutic Workplace wage supplement program in promoting drug abstinence, increasing employment, and reducing poverty (Holtyn et al, 2020a). Individuals with opioid use disorder and a history of unemployment participated in the program for 15 months, starting with 3 months of paid job skills training in which maximum pay was available for opioid and then opioid and cocaine abstinence.…”

“…The Therapeutic Workplace wage supplement program was effective at reducing drug use, increasing employment, and reducing poverty during the year the intervention was in place (Holtyn et al, 2020a). Over 65% of the participants who became employed were employed in their jobs consistently over several weeks (Holtyn et al, 2021a).…”

“…Governments, nonprofits, and researchers may be interested in developing wage supplement programs to promote employment and improve health in socioeconomically disadvantaged populations. Drug abstinence responds well to conditional cash transfers, and so does employment (Holtyn et al, 2020a); however, promoting steady employment in high-wage jobs can prove difficult. Based on the available evidence, programs should offer education; provide individualized, stipend-supported job-seeking and employment services; and design incentive systems based on the science of operant conditioning.…”